Small businesses can shop off-exchange through a broker, buy directly from a...

https://melissazxlth.gumroad.com/p/primary-care-doctor-not-in-network-what-should-i-do-as-an-employer

Small businesses can shop off-exchange through a broker, buy directly from a carrier, or compare small-group plans; some may consider an HRA instead. Before weighing prices, check whether employees’ doctors and nearby hospitals are in-network.